RSV in children: an evolving story from high burden to universal prevention.

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection and hospitalization in infants worldwide, with a substantial clinical and socioeconomic burden. For decades, preventive strategies were limited to high-risk populations, with minimal impact at the population level. Recent advances in RSV virology and immunology have transformed prevention. This review summarizes RSV epidemiology, key pathogenetic mechanisms, and current preventive strategies, with a focus on long-acting monoclonal antibodies and maternal vaccination. Evidence from randomized clinical trials, real-world studies, and international recommendations is critically appraised, with emphasis on implementation strategies and emerging preventive tools. These developments mark a shift from risk-based prophylaxis to broader, population-level prevention, with the potential to substantially reduce RSV-related morbidity and healthcare burden in early childhood.